Primary Predictor Of Interest Research Articles

Determining Associations Between Intervention Amount and Outcomes for Young Autistic Children

Health professionals routinely recommend intensive interventions (ie, 20-40 hours per week) for autistic children. However, primary research backing this recommendation is sparse and plagued by methodological flaws. To examine whether different metrics of intervention amount are associated with intervention effects on any developmental domain for young autistic children. A large corpus of studies taken from a recent meta-analysis (with a search date of November 2021) of early interventions for autistic children. Studies were eligible if they reported a quasi-experimental or randomized clinical trial testing the effects of a nonpharmacological intervention on any outcome in participant samples comprising more than 50% autistic children 8 years or younger. Data were independently extracted by multiple coders. Meta-regression models were constructed to determine whether each index of intervention amount was associated with effect sizes for each intervention type, while controlling for outcome domain, outcome proximity, age of participants, study design, and risk of detection bias. Data were analyzed from June 2023 to February 2024. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary predictor of interest was intervention amount, quantified using 3 different metrics (daily intensity, duration, and cumulative intensity). The primary outcomes of interest were gains in any developmental domain, quantified by Hedges g effect sizes. A total of 144 studies including 9038 children (mean [SD] age, 49.3 [17.2] months; mean [SD] percent males, 82.6% [12.7%]) were included in this analysis. None of the meta-regression models evidenced a significant, positive association between any index of intervention amount and intervention effect size when considered within intervention type. Findings of this meta-analysis do not support the assertion that intervention effects increase with increasing amounts of intervention. Health professionals recommending interventions should be advised that there is little robust evidence supporting the provision of intensive intervention.

Association of social determinants of health-related diagnosis codes with postoperative outcomes.

The association of an individual's social determinants of health-related problems with surgical outcomes has not been well-characterized. The objective of this study was to determine whether documentation of social determinants of a health-related diagnosis code (Z code) is associated with postoperative outcomes. This retrospective cohort study included surgical cases from a single institution's national surgical quality improvement program (NSQIP) clinical registry from October 2015 to December 2021. The primary predictor of interest was documentation of a Z code for social determinants of health-related problems. The primary outcome was 30-day postoperative morbidity. Secondary outcomes included postoperative length of stay, disposition, and 30-day postoperative mortality, reoperation, and readmission. Multivariable regression models were fit to evaluate the association between the documentation of a Z code and outcomes. Of 10,739 surgical cases, 348 patients (3.2%) had a documented social determinants of health-related Z code. In multivariable analysis, documentation of a Z code was associated with increased odds of morbidity (20.7% vs. 9.9%; adjusted odds ratio [aOR], 1.88; 95% confidence interval [CI], 1.39-2.53), length of stay (median, 3 vs. 1day; incidence rate ratio, 1.49; 95% CI, 1.33-1.67), odds of disposition to a location other than home (11.3% vs. 3.9%; aOR, 2.86; 95% CI, 1.89-4.33), and odds of readmission (15.3% vs. 6.1%; aOR, 1.99; 95% CI, 1.45-2.73). Social determinants of health-related problems evaluated using Z codes were associated with worse postoperative outcomes. Improved documentation of social determinants of health-related problems among surgical patients may facilitate improved risk stratification, perioperative planning, and clinical outcomes.

The pervasive association between political ideology and COVID-19 vaccine uptake in Brazil: an ecologic study

BackgroundDespite the unequivocal benefits of vaccination, vaccine coverage has been falling in several countries in the past few years. Studies suggest that vaccine hesitancy is an increasingly significant phenomenon affecting adherence to vaccines. More recently, during the COVID-19 pandemic, political views have emerged as an additional influencing factor for vaccine hesitancy.MethodsIn this ecologic study, we used information from publicly available databases to investigate the association between political ideology, depicted by the percentage of votes for the right-wing candidate Jair Bolsonaro in the presidential elections of 2018 and 2022, and COVID-19 vaccination in Brazilian municipalities. The primary endpoint was the COVID-19 vaccination index, calculated as the number of COVID-19 vaccine doses administered up to September 2022 divided by the number of inhabitants in each municipality. The analysis was conducted using Pearson correlation coefficients and linear regression models adjusted for HDI, the percentage of male voters, the percentage of voters who were older than 50 years old, and the percentage of voters with a middle school education or less. In addition, we explored whether the effect of the percentage of Bolsonaro voters on the COVID-19 vaccination index was modified in different quartiles of HDI using an interaction term.ResultsFive thousand five hundred sixty-three Brazilian municipalities were included in the analysis. For both the 2018 and 2022 elections, the percentage of votes for Jair Bolsonaro was significantly and inversely associated with COVID-19 vaccine uptake after adjustment for the sociodemographic characteristics of the voters (change in mean vaccination index in 2018 for each 1% increase in Bolsonaro voters -0.11, 95% confidence interval [CI] -0.13 to -0.08, p < 0.001; change in mean vaccination index in 2022 for each 1% increase in Bolsonaro voters -0.09, 95% CI -0.11 to -0.07, p < 0.001). We also found a statistically significant interaction between the primary predictor of interest and HDI scores, with a more significantly detrimental effect of the right-wing political stance in municipalities in the lower HDI quartiles (interaction p < 0.001 for the first HDI quartile; p = 0.001 for the second HDI quartile).ConclusionOur findings suggest that political ideologies have influenced COVID-19 vaccine hesitancy in Brazilian municipalities, affecting communities inequitably. The politicization of vaccines is a new challenge for vaccine programs. Strategies to face these challenges should include joint efforts from governments and civil society for a common public health goal.

Association Between Nociplastic Pain and Pain Severity and Impact in Women With Chronic Pelvic Pain

Exploring the relationship between nociplastic pain and the severity and impact of pelvic pain symptoms could lend insight into the heterogeneous symptom presentation and treatment response that complicates management of chronic pelvic pain. In this prospective cross-sectional study, we sought to evaluate relationships between degree of nociplastic pain, measured by the Fibromyalgia (FM) Survey Score, and multiple aspects of the chronic pelvic pain (CPP) experience, including severity, frequency, tenderness during pelvic myofascial exam, interference with daily life, and high-impact pain. The study included 303 women who presented to a tertiary referral clinic for chronic pelvic pain and endometriosis. Multiple measures of pelvic pain, including pain severity, frequency, interference, pelvic myofascial pain, and high-impact pain were examined in General Linear Models with FM Survey Score as the primary predictor of interest in models controlling for endometriosis, surgical history, use of opioids, body mass index, and patient age. Higher level of nociplastic pain was associated with greater pelvic pain severity, frequency, interference, and pelvic myofascial pain (all P < .05). For all models, degree of nociplastic pain was more strongly associated with pain outcomes than the presence of endometriosis, and use of opioids was the only stronger predictor of worse pain outcomes. The likelihood of high impact pain increased 7% for each additional point on the FM Survey Score. Degree of nociplastic pain was robustly associated with severity, frequency, and impact of pelvic pain, and was independent of the presence of endometriosis, history of surgical procedures for pelvic pain, age, and BMI.Trial registration: not applicable PerspectiveThis article evaluates the impact of nociplastic pain on symptoms and functional status in chronic pelvic pain. These findings raise the possibility that a simple screening tool for nociplastic pain might provide clinically actionable information without the need for deep neurobiological phenotyping and may inform development of personalized management strategies.

Rural, Large Town, and Urban Differences in Optimal Subspecialty Follow-up and Survivorship Care Plan Documentation among Childhood Cancer Survivors.

Children with cancer from rural and nonurban areas face unique challenges. Health equity for this population requires attention to geographic disparities in optimal survivorship-focused care. The Oklahoma Childhood Cancer Survivor Cohort was based on all patients reported to the institutional cancer registry and ≤ 18 years old at diagnosis between January 1, 2005, and September 24, 2014. Suboptimal follow-up was defined as no completed oncology-related clinic visit five to 7 years after their initial diagnosis (survivors were 7-25 years old at end of the follow-up period). The primary predictor of interest was rurality. Ninety-four (21%) of the 449 eligible survivors received suboptimal follow-up. There were significant differences (P = 0.01) as 36% of survivors from large towns (n = 28/78) compared with 21% (n = 20/95) and 17% (n = 46/276) of survivors from small town/isolated rural and urban areas received suboptimal follow-up, respectively. Forty-five percent of adolescents at diagnosis were not seen in the clinic compared with 17% of non-adolescents (P < 0.01). An adjusted risk ratio of 2.2 (95% confidence interval, 1.5, 3.2) was observed for suboptimal follow-up among survivors from large towns, compared with survivors from urban areas. Seventy-three percent of survivors (n = 271/369) had a documented survivorship care plan with similar trends by rurality. Survivors from large towns and those who were adolescents at the time of diagnosis were more likely to receive suboptimal follow-up care compared with survivors from urban areas and those diagnosed younger than thirteen. Observed geographic disparities in survivorship care will inform interventions to promote equitable care for survivors from nonurban areas.

Increasing Serum Bicarbonate is Associated With Reduced Risk of Adverse Kidney Outcomes in Patients with CKD and Metabolic Acidosis

Low serum bicarbonate at a single point in time is associated with accelerated kidney decline in patients with chronic kidney disease (CKD). We modeled how changes in serum bicarbonate over time affect incidence of adverse kidney outcomes. We analyzed data from Optum's deidentified Integrated Claims-Clinical data set of US patients (2007-2019) with≥1 year of prior medical record data, CKD stages G3 to G5, and metabolic acidosis (i.e., index serum bicarbonate 12 to<22 mmol/l). The primary predictor of interest was the change in serum bicarbonate, evaluated at each postindex outpatient serum bicarbonate test as a time-dependent continuous variable. The primary outcome was a composite of either a≥40% decline in estimated glomerular filtration rate (eGFR) from index or evidence of dialysis or transplantation, evaluated using Cox proportional hazards models. A total of 24,384 patients were included in the cohort with median follow-up of 3.7 years. A within-patient increase in serum bicarbonate over time was associated with a lower risk of the composite kidney outcome. The unadjusted hazard ratio (HR) per 1-mmol/l increase in serum bicarbonate was 0.911 (95% confidence interval [CI]: 0.905-0.917; P< 0.001). After adjustment for baseline eGFR and serum bicarbonate, the time-adjusted effect of baseline eGFR and other covariates, the HR per 1-mmol/l increase in serum bicarbonate was largely unchanged (0.916 [95% CI: 0.910-0.922; P< 0.001]). In a real-world population of US patients with CKD and metabolic acidosis, a within-patient increase in serum bicarbonate over time independent of changes in eGFR, was associated with a lower risk of CKD progression.

The potential protective benefit of personality on subjective cognitive decline related worry: Results from the Canadian Longitudinal Study on Aging (CLSA)

AbstractBackgroundSubjective cognitive decline (SCD), a self‐reported decline in cognition, may be a risk factor for Alzheimer’s disease. Recently, SCD‐related worry has been implicated in predicting the progression from SCD to further cognitive decline. Certain personality traits have been linked to cognitive health (i.e., conscientiousness, emotional‐stability, and openness to experience), but little is known about the association between personality traits and worry related to perceived cognitive decline.MethodAnalyzing data from the Canadian Longitudinal Study on Aging (CLSA), a large national study of participants aged 45‐85 at baseline, we sought to identify prospective psychosocial correlates of SCD‐related worry. At baseline, known correlates of cognition (e.g., depression) were measured, as well as the primary predictor of interest, personality traits, which were measured using the Ten‐Item Personality Inventory (TIPI). SCD and SCD‐related worry were measured three years later. Participants who positively endorsed SCD at follow‐up were asked a single‐item assessing their worry about their self‐reported memory decline. Response options ranged from disagree to agree. Multiple imputation using chained equations (MICE) was conducted to account for missing data. An ordinal logistic regression model was used to estimate the odds of reporting greater SCD‐related worry (n = 27,745).ResultMany psychosocial measures were associated with greater SCD‐related worry, for example, being a woman (OR = 1.35, CI: 1.25‐1.45), being younger (OR = 0.99, CI: 0.97‐0.99), and elevated depression symptoms (OR = 1.44, CI: 1.32‐1.58). With respect to personality traits, higher levels of certain traits were associated with reduced odds of SCD‐related worry: extraversion (OR = 0.96, CI: 0.95‐0.98), conscientiousness (OR = 0.95, CI: 0.92‐0.97), and emotional stability (OR = 0.86, CI: 0.84‐0.88). Openness to experience (OR = 1.01, CI: 0.99‐1.03), and agreeableness (OR = 1.00, CI: 0.97‐1.03), were not associated with SCD‐related worry.ConclusionHigher levels of extraversion, conscientiousness, and emotional stability were associated with higher worry regarding perceived decline in cognitive functioning. This information may help identify individuals at a greater risk of future cognitive impairment and dementia.

Disparities in overall survival (OS) outcomes based on treating facility volume in pancreatic neuroendocrine tumors.

150 Background: Pancreatic neuroendocrine tumors (pNETs) comprise less than 5% of all pancreatic tumors and 7% of all neuroendocrine tumors (NETs). There has been considerable progress in understanding the biology of pNETs and numerous therapeutic options emerged, especially with the collaboration of various specialties in the multidisciplinary setting. In this this study, we sought to analyze the association of facility volume, treatment modalities offered, and different risk adjusted outcomes in pNETs. Methods: We extracted data from National Cancer Data Base (NCDB) that covers 70% of all newly diagnosed cancer cases in the U.S and Puerto Rico. Patients with pNETs diagnosed between 2004 &amp; 2017 were included and classified into tertiles based on hospital volume. Volume–outcome relationship was determined by using Cox regression adjusting for patient demographics, comorbidities, tumor characteristics, insurance type and therapy received. Kaplan Meier estimates of OS were compared with log-rank test. The primary predictor of interest was the facility volume defined as number of pNETs treated/year. A total of 7202 patients with pathologically confirmed pNETS were treated at 840 facilities. The median annual facility volume was 5patients/year. Facilities were classified into (T:mean cases/year) T1: &lt; 3; T2:4-8; T3:≥9 cases/year. Results: A total of 7202 pNET patients were treated at 840 facilities. The median annual facility volume was 5 patients/year. Facilities were classified into (T: mean cases/year) T1:&lt;3; T2:4-8; T3:≥9 cases/year. The unadjusted median OS by facility volume was: T1: 71 months (m), T2: 136 m, and T3: not-reached (p &lt; 0.001). On multivariable analysis, compared with patients treated at T3 facilities, patients treated at lower-tertile facilities had higher risk of death [T2 hazard ratio (HR), 1.17 (95% CI, 1.03-1.33); T1 HR, 1.45 (CI, 1.30-1.67), p &lt; 0.0001] and such a difference in OS was more pronounced in stage IV disease (Table). Patients at T3 facilities (vs T1) were more likely to receive surgical resection of the primary tumor (75 vs 49%), lymph node dissection performed at the time of surgery (70 vs 42%), and a better R0 resection (72 vs 46%) (p &lt; 0.01). Conclusions: Patients who were treated for pNETs at high-volume centers (&gt; 9cases/year) had significantly higher OS and were more likely to receive surgical resection along with lymph node dissection and R0 resection. There was a 45% increased risk of death in patients treated at low volume centers (&lt; 3/year) as compared to high-volume centers (&gt; 9/year). While OS difference was noticed in all stages, the difference was more pronounced in stage IV disease demonstrating the importance of multi-disciplinary approach in pNETs management and incorporating such quality measures in low-volume facilities.[Table: see text]

US soldiers and the role of leadership: COVID-19, mental health, and adherence to public health guidelines

BackgroundPrevious studies have documented the impact of domain-specific leadership behaviors on targeted health outcomes in employees. The goal of the present study was to determine the association between specific leadership behaviors addressing COVID-19 and US soldiers’ mental health and adherence to COVID-19 public health guidelines.MethodsAn electronic, anonymous survey was administered to US Army soldiers across three major commands (N = 7,829) from December 2020 to January 2021. The primary predictor of interest was soldiers’ ratings of their immediate supervisors’ behaviors related to COVID-19. The outcomes were soldiers’ mental health (i.e., depression and generalized anxiety) and adherence to COVID-19 public health guidelines. Covariates were rank, gender, ratings of immediate supervisors’ general leadership, level of COVID-19 concerns, and COVID-19 status (e.g., tested positive, became seriously ill). Logistic regressions were used to model the unique association of COVID-19 leadership behaviors with outcomes after adjusting for covariates.ResultsHigh levels of COVID-19 leadership behaviors were associated with lesser likelihood of soldiers’ screening positive for depression (AOR = 0.46; 95% CI [0.39, 0.54]) and anxiety (AOR = 0.54; 95% CI [0.45, 0.64]), and greater likelihood of frequent adherence to preventive health guidelines (AORs = 1.58; 95% CI [1.39, 1.80] to 2.50; 95% CI [2.01, 3.11]).ConclusionHigher levels of COVID-19 leadership behaviors may support soldiers’ mental health and encourage their adherence to COVID-19 public health guidelines. Given the link between these leader behaviors and soldier adaptation to the pandemic over and above general leadership, training for supervisors should focus on targeting specific health-promoting behaviors. Results can inform leader training for the military and other high-risk occupations.

Is Frailty Index a better predictor than pre-stroke modified Rankin Scale for neurocognitive outcomes 3-months post-stroke?

BackgroundThe prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated.AimsThe aim of this study was to compare the predictive value of pre-stroke FI with pre-stroke modified Rankin Scale (mRS) for post-stroke cognitive impairment. Further, we explored the added value of including FI in prediction models for cognitive prognosis post-stroke.MethodsWe generated a 36-item Frailty Index (FI), based on the Rockwood FI, to measure frailty based on pre-stroke medical conditions recorded in the Nor-COAST multicentre prospective study baseline assessments. Consecutive participants with a FI score and completed cognitive test battery at three months were included. We generated Odds Ratio (OR) with NCD as the dependent variable. The predictors of primary interest were pre-stroke frailty and mRS. We also measured the predictive values of mRS and FI by the area (AUC) under the receiver operating characteristic curve.Results598 participants (43.0% women, mean/SD age = 71.6/11.9, mean/SD education = 12.5/3.8, mean/SD pre-stroke mRS = 0.8/1.0, mean/SD GDS pre-stroke = 1.4/0.8, mean/SD NIHSS day 1 3/4), had a FI mean/SD score = 0.14/0.10. The logistic regression analyses showed that FI (OR 3.09), as well as the mRS (OR 2.21), were strong predictors of major NCD. When FI and mRS were entered as predictors simultaneously, the OR for mRS decreased relatively more than that for FI. AUC for NCD post-stroke was higher for FI than for mRS, both for major NCD (0.762 vs 0.677) and for any NCD (0.681 vs 0.638).ConclusionsFI is a stronger predictor of post-stroke NCD than pre-stroke mRS and could be a part of the prediction models for cognitive prognosis post-stroke.Trial RegistrationClinicalTrials.gov Identifier: NCT02650531.

Heteroscedasticity testing for semi-parametric multi-index models based on the partial sufficient dimension reduction method

Heteroscedasticity testing is an important issue in regression analysis. In this paper, a model-adaptive test statistic is proposed for the semi-parametric multi-index model. The semi-parametric model studied in this paper includes two types of predictors, namely the predictors of primary interest $X$ and the predictors of secondary interest $W$. In general, the dimension of the variable $X$ is relatively high, leading to the greatly reduced accuracy of the non-parametric estimation.Meanwhile, the existence of the secondary variable $W$ makes the traditional sufficient dimension reduction methods no longer applicable.In this paper, a dimension-reduction test statistic is constructed based on the partial sufficient dimension reduction method, which effectively avoids the estimation difficulties caused by high-dimensional variables. The statistic can be adaptive to many different model structures and thus has good robustness. The asymptotic properties of the proposed test statistic are studied under the null hypothesis and the alternative hypothesis. Simulations and real data examples are given to illustrate the finite sample performance of the test.

Social Connectedness and Communication Technology Among Paid and Unpaid Caregivers of Middle-Aged and Older Adults

Objective: To examine differential relationships between communication technology use and social connectedness among paid and unpaid caregivers providing care for middle-aged and older adults. Methods: This nationwide study utilized a cross-sectional Qualtrics panel survey from caregivers, ages 50 years and older (n=504) of middle-aged and older adults. About 17% were paid (n=86) and 83% (n=418) were unpaid caregivers. Primary outcomes were caregivers’ sense of belonging to their local community and social bonds. The primary predictor of interest was caregivers’ use of communication technology (texting/communication applications). A multivariable regression analysis was performed to predict each outcome based on communication technology use, separately among paid and unpaid caregivers. Multivariable regression analyses were repeated after including the caregivers’ payment status (paid/unpaid) and the interaction term between the caregivers’ payment status and the use of communication technology. The models were adjusted for caregivers’ age, education, financial status, place of residence, and total weekly hours of caregiving. Results: Use of communication technology had a statistically-significant positive association with sense of belonging only among paid caregivers (b=25.8, p=.005). The relationship between use of communication technology and sense of belonging was significantly different between paid and unpaid caregivers (p=.005). Use of communication technology was significantly associated with social bonds only among unpaid caregivers (b=0.4, p<.001). There was no statistically-significant differential association between communication technology use and social bonds. Conclusion: Communication technology may play differential roles in linking paid and unpaid caregivers with their community and interpersonal groups. Additional efforts should examine mechanisms that provide meaningful caregiver support.

International Socioeconomic Predictors of Colon and Rectal Cancer Mortality: Is Colorectal Cancer a First World Problem?

PURPOSEColorectal cancer (CRC) is a leading cause of international morbidity and is the second highest cause of cancer-related mortality in the world. The purpose of this study was to investigate the relationship between international health care spending on CRC mortality over time.METHODSThis is a retrospective study using a publicly available data from the WHO Global Health Observatory database. General estimating equations were used to analyze the relationship between total health care expenditure per capita (THEpc) and CRC mortality at the country level. The primary predictors of interest were quartiles of THEpc. Other exposure variables included gross domestic product per capita (GDPpc), smoking (% of adult population smoking), physician density (per 10,000), and time.RESULTSMortality decreased significantly from 2000 to 2016 (coefficient [95% CI], −2.2 [−3.3 to −1.1]; P < .001). THEpc, GDPpc, time, and percentage of adult population smoking were significant predictors of CRC mortality. Patients in the top two quartiles of THEpc had 3% higher rates of CRC mortality compared with countries in Q1 THEpc (Q3: 3.4 [1.9-4.8], P < .001; Q4: 3.2 [1.4-5.0], P = .001). Similar trends were seen in GDPpc (Q4: 3.2 [1.4-5.0], P = .001; Q3: 3.4 [1.9-4.8], P < .001; Q2: 1.7 [0.7-2.6], P < .001; Q1: reference).CONCLUSIONOverall, mortality decreased significantly over the study period. Countries with higher health expenditures and higher gross domestic products experienced higher rates of CRC mortality. Further research will be necessary to determine the cause for this, but we postulate that it may be a result of more robust diagnostic and follow-up methods in countries with more resources.

Predictors of Severe Chemoradiation-Related Lymphopenia in Patients With Anal Squamous Cell Carcinoma

Treatment-related lymphopenia may be prognostic for poorer survival in anal squamous cell carcinoma (ASCC). With current randomized trials evaluating the potential role of immunotherapy in localized ASCC, the contribution of host immunity will become increasingly important. We sought to identify clinical, tumor, and dosimetric predictors for severe lymphopenia during chemoradiation (CRT) for ASCC.Patients who underwent CRT for ASCC from 2008-2020 at two Comprehensive Cancer Centers were identified and charts were reviewed. Only those who received 5-fluorouracil and mitomycin C concurrent with IMRT to 50.4-59.4 Gy were included. Lymphopenia was graded per CTCAE v5.0 with absolute lymphocyte count (ALC) nadir < 0.2×109/L indicating grade 4 toxicity. Logistic regression was used to distinguish the effects directly attributable to radiation exposure from contextual covariates. The outcome was presence of grade 4 lymphopenia. The primary predictors of interest were iliac crest V40 and total prescription dose (TPD). It was hypothesized that higher iliac crest V40 and higher TPD would be positively associated with severe lymphopenia. PTV total volume (PTVtv) and GTVp volume were also included and interactions with dose were examined for each. Lastly, covariates included history of malignancy, age, and pre-treatment ALC. These variables were selected because literature has identified them as relevant to lymphopenia in other samples.A total of 119 patients were identified with a median age of 59 years. Forty-seven patients (39%) had T3/4 disease and 57 patients (49%) had node positive disease. Fifty-eight patients (49%) developed grade 4 lymphopenia during CRT or within 1 month of completing treatment. On multivariate analysis pre-treatment ALC (P = 0.006, OR = 0.31), GTVp volume (P = 0.010, OR = 1.23), and iliac crest V40 (P = 0.013, OR = 1.08) were predictive of grade 4 lymphopenia. History of previous malignancy was associated with reduced risk of grade 4 lymphopenia (P = 0.030, OR = 0.04). TPD and PTVtv were not independently predictive of grade 4 lymphopenia, though patients with a higher TPD and smaller PTVtv were significantly more likely to develop grade 4 lymphopenia (P = 0.038) compared to those with both high TPD and PTVtv or both low TPD and PTVtv.Severe lymphopenia is common during CRT for ASCC and certain patients are at higher risk for developing this treatment-related toxicity. Pre-treatment lymphocyte count, larger tumor volume, and dose to the iliac crests are each independent predictors of grade 4 lymphopenia. Additionally, closer observation should be employed when treating patients with higher prescription doses and smaller PTV total volumes. With ongoing efforts to incorporate immunotherapy in the treatment of ASCC, using predictors to detect patients at risk for severe lymphopenia will be increasingly important.

Difficulties in psychosocial functioning due to current depressive symptoms: What can C-Reactive protein tell us?

BackgroundMultiple empirical studies and meta-analyses have examined how inflammation may be associated with various aspects of major depression, with older adults being particularly at risk for the effects of inflammation-related depression. Despite this wide area of research, no study has examined how depression-related inflammation impacts psychosocial functioning. MethodsData from the National Health and Nutrition Examination Survey, years 2007–2008, were utilized to examine whether adults over the age of 40 experienced difficulty in their work, taking care of things at home, or getting along with other people due to current depressive symptoms through a logistic regression analysis. We selected C-reactive protein (CRP), a common marker of immune system activation, as our primary predictor of interest while controlling for relevant covariates. ResultsGreater CRP was positively associated with a greater risk for individuals experiencing difficulties in psychosocial functioning due to depressive symptoms. While current number and severity of depressive symptoms was also found to be significant in the model, comparison of effect sizes identified that CRP appears to be a more relevant marker for experiencing difficulty than a number of relevant biopsychosocial covariates. ConclusionInflammation as measured by CRP may be a helpful tool in understanding how depressive symptoms are associated with an individual's ability to successfully navigate their social environment. Results here demonstrate the emerging utility of CRP in helping to assess the risk for negative outcomes in those experiencing depressive symptoms, especially as it pertains to older adults.

Association of entirely claims-based frailty indices with long-term outcomes in patients with acute myocardial infarction, heart failure, or pneumonia: a nationwide cohort study in Turkey.

BackgroundSeveral countries have increasingly focused on improving care for acute myocardial infarction (AMI), heart failure (HF), and pneumonia to reduce their readmissions and mortality rates. Frailty is becoming increasingly important to accurately predict healthcare utilization for the aging population. The preferred method for the measurement of frailty remains unclear, and current risk-adjustment models do not account for frailty. We sought to compare commonly used frailty indices in terms of the ability to predict clinical adverse outcomes in AMI, HF, and pneumonia patients.MethodsA nationwide cohort study included AMI, HF, and pneumonia with 65 years and older patients in the Turkey between January 1 and December 31, 2018. The primary predictor of interest was frailty. We used two claims-based frailty indices (Johns Hopkins Claims-Based Frailty Index and Hospital Frailty Risk Score) to assess frailty. The main outcome was all-cause long-term mortality up to 3 years. Time to death was calculated as the time period between the date of first admission and the date of death. Patients were censored as of September 30, 2020, which marked the end of the follow-up period.FindingsOf the 200,948 patients, 35,096 (17.5%) had AMI, 62,403 (31.1%) had HF, and 103,449 (51.5%) had pneumonia. Johns Hopkins Claims-Based Frailty Index (c-statistics for long-term mortality: 0.68 in AMI, 0.61 in HF, 0.64 in pneumonia) was better compared to Hospital Frailty Risk Score (c-statistics for long-term mortality: AMI=0.62, HF=0.58, pneumonia=0.62) (DeLong p<0.001 in all).InterpretationReadmission and mortality rates after AMI, HF, and pneumonia gradually increases with increasing frailty score. While the Hospital Frailty Risk Score had a better discrimination for predicting readmissions, Johns Hopkins Claims-Based Frailty Index had a better discrimination for predicting mortality. These findings should be taken into account for a better evaluation of hospital performance.FundingThis study was supported by funding from The Scientific and Technological Research Council of Turkey (grant 120S422, HK).

Turnover events of animal caretakers and its impact on productivity in swine farms

Attracting and retaining quality animal caretaking personnel is one of most pressing issues the US swine industry currently faces. On-farm employee turnover can be costly and have an impact on productivity. The primary objectives of this study were to describe the amount of animal caretaker turnover events that occurred in a single year in eleven swine farms, and to investigate associations between employee turnover events and two subsequent production parameters of interest: number of pigs weaned per sow (PWS) and pre-weaning mortality (PWM). A retrospective cohort study was conducted with eleven commercial farrow-to-wean swine farms belonging to two vertically integrated multi-site production systems within two swine production companies. Human resources and production data for the year of 2019 were obtained monthly from each farm. The primary predictor of interest was the occurrence of an employee turnover event, defined as ‘voluntary’ (employee decided to leave or quit) or ‘involuntary’ (employee was terminated by company decision). The primary outcomes of interest included the monthly average PWS and PWM. These associations were assessed with 1-, 2-, 3-, and 6-months between the turnover events and the outcome. Linear mixed effects models were fit in STATA 15, with system and farm included as random effects. To account for temporal and seasonal trends of production, season and the monthly production were included in the models. There were a total of 152 turnover events, with 4 and 148 turnover events in systems 1 and 2, respectively. The average turnover, calculated as a percent of total turnover among full time employee positions, was 92 % (SD = 62 %; Range = 8–217 %). Improved production efficiency in both monthly PWS (p = 0.01) and PWM (p = 0.02) was observed with the occurrence of an involuntary turnover event two months prior, after controlling for season, previous month production, farm, and system. For the PWS outcome, there was a significant interaction between an involuntary turnover event two months prior and monthly county-level unemployment rate (p = 0.02), indicative of the improved performance being most profound at the lowest levels of unemployment rate and diminishing at the highest levels. Turnover of animal caretaking personnel in farrow-to-wean farms was confirmed to be highly variable and high for the majority of farms in this study. Furthermore, animal caretaker turnover was associated with subsequent trends of production efficiency, warranting closer consideration of prioritizing managerial efforts in worker recruitment, training and retention.

Over-the-counter oral contraceptive use among women in Mexico: results from a national survey

AimIn Mexico, many pharmacies sell oral contraceptives (OCs) over the counter (OTC); however, little is known about the background characteristics of OTC pill users. The primary objective of this study...

Gender differences in time from arrival to stroke team activation in patients presenting with acute stroke symptoms

Background and Purpose: Women are more likely to experience delays in evaluation and treatment for acute stroke. As national guidelines increasingly emphasize the importance of rapid stroke intervention, it is important to further investigate this gender disparity. We sought to evaluate whether door-to-stroke activation time varied by patient gender among patients for whom stroke team activation occurred in the emergency department (ED). Methods: This was a retrospective analysis of a prospectively collected registry of all patients for whom the stroke team was activated in the ED of an urban, academic, regional stroke center over 1 year. Our primary outcome was door to stroke activation time (DTA), with the primary predictor of interest being patient gender. We assessed for differences in DTA using multivariable Cox proportional hazards and logistic regression models. Results: There were 211 patient encounters included in the study, 117 women and 94 males. Median DTA was 8 minutes longer for women, and women were less likely to have DTA ≤ 15 minutes (odds ratio 0.26 [95% confidence interval 0.12 to 0.58]). Conclusion: A gender disparity existed in door to activation time for women presenting with suspected acute stroke, even when controlling for a variety of factors. These results provide evidence that gender may impact initial management of stroke patients.

Abstract PO-138: Perceptions and patterns of cigarette and e-cigarette use among Hispanics: A heterogeneity analysis of the 2017-2019 HINTS

Abstract Background: There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns and perceptions of e-cigarette use. Objective: The study aims to identify social and demographic patterns of heterogeneity in cigarette and e-cigarette perceptions and use among Hispanic adults. Methods: Using data from the Health Information National Trends Survey (HINTS) 5 cycle 1, HINTS 5 cycle 2, and HINTS 5 cycle 3, we examined cigarette and e- cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors of interest were Hispanic ethnic group (Mexican/Mexican American, Puerto Rican, Cuban, and other Hispanic), gender, age, education, income, and English language proficiency with adjustments for personal and family cancer history, and survey year. Binary outcomes were modeled using the logit link and multinomial outcome variables were modeled using generalized logit model. All analyses were done using SAS 9.4® using complex survey methodology with jackknife replicate weights for accurate standard errors, with all analyses weighted to provide nationally representative estimates. Results: The weighted proportion of Hispanics participants who self-identified as Mexican were 53.3%. Puerto-Ricans represented 8% of the participants. Cubans accounted for just about 4% of the responders. The remaining 35% were identified as other Hispanics. Of the 1,618 respondents, 23% were former cigarette smokers, 10% were current cigarette smokers. Twenty percent reported a history of electronic cigarette use, 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report being ever smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Hispanics with lower English proficiency were also significantly less likely to report being ever smokers compared to Hispanics who spoke English well (aOR = 0.42, 95% CI = 0.20, 0.85). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI – 1.11, 5.11) compared to Mexicans. Hispanics with a history of cancer were significant more likely to report e-cigarette use (aOR = 3.45, 95% CI = 1.04, 11.50); they were also more likely to report e-cigarette use as less harmful than cigarette use. E-cigarette use among Hispanics has also significantly increased across HINTS cycles, while smoking has remained unchanged. Conclusions: Among Hispanics, significant differences in e-cigarette and cigarette use behaviors and perceptions emerged by gender, age, ethnicity, and cancer history. Implications for tailoring smoking prevention and cessation messaging should be considered. Citation Format: Marlene Camacho-Rivera, Rose Calixte, Denise C. Vidot, Jessica Y. Islam. Perceptions and patterns of cigarette and e-cigarette use among Hispanics: A heterogeneity analysis of the 2017-2019 HINTS [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-138.